Juan Murube, MD, PhD (Spain) THE TWO EASIEST SURGERIES TO TREAT DRY EYE: 1. PUNCTUM PATCHING 2. CISTERNOPLASTY _____________________________

WHY SPEAK ABOUT THE SURGICAL TREATMENT OF DRY EYE? DRY EYE IS THE MOST FREQUENT DISEASE IN OPHTHALMOLOGY. DRY EYE AND GLAUCOMA ARE AT PRESENT THE MOST FREQUENT CHRONIC MEDICAL TREATMENTS IN OPHTHALMOLOGY. ALL PEOPLE WILL SUFFER DRY EYE IF THEY LIVE LONG ENOUGH. AT PRESENT DRY EYE HAS NO CURE, AND TREATMENT IS ONLY PALLIATIVE IN THE NEAR FUTURE, SURGICAL TREATMENT OF DRY EYE WILL GREATLY INCREASE IN FREQUENCY.

THE TRIPLE CLASSIFICATION OF DRY EYE I. ETIOPATHOGENIC II. HISTOGLANDULARIII. SEVERITY 1. Age-related A queo-deficient 1. Mild. 2. Hormonal L ipo-deficient 2. Moderate 3. Pharmacologic M ucin-deficient 3. Severe 4. Immunopathic E pitheliopathic 5. Hyponutritional N on ocular dryness 6. Dysgenetic 7. Adenitic 8. Traumatic 9. Neurodeprivative 10. Tantalic

SURGICAL TREATMENT 1. SUPPLYING FLUID TO THE LACRIMAL POOL PAROTID DUCT TRANSPOSITION SALIVARY GLAND TRANSPLANTATION ABDOMINAL RESERVOIR 2. RETAINING FLUID IN THE LACRIMAL POOL PUNCTUM OCCLUSION CISTERNOPLASTY

STENO’s DUCT TRANSPOSITION, 1951

TRANSPLANTATION OF MAJOR SALIVARY GLANDS to the TEMPORAL FOSSA, 1986

TRANSPLANTATION OF MINOR GLANDS (f.i. labial) TO THE SURFOCULUS

SUBCUTANEOUS ABDOMINAL RESERVOIRS

SURGICAL TREATMENT 1. SUPPLYING FLUID TO THE SURFOCULAR POOL PAROTID DUCT TRANSPOSITION SALIVARY GLAND TRANSPLANTATATION ABDOMINAL RESERVOIR 2. RETAINING FLUID IN THE SURFOCULAR POOL PUNCTUM OCCLUSION CISTERNOPLASTY

3 METHODS FOR THERMAL OCCLUSION: 1. GALVANOCAUTEY 2. DIATHERMY 3. LASER

PUNCTUM PLUGS iniciated by Freeman in 1975

PUNCTUM OCCLUSION WITH SMART PLUGS

PATCHING OF THE LACRIMAL PUNCTUM with autologous conjunctiva

PUNCTUM PATCHING with AUTOLOGOUS SKIN

2, CISTERNOPLASTY -THE VOLUME OF A NORMAL LACRIMAL BASIN IS ≈ 7 μl. -A DROP OF ARTIFICIAL TEAR HAS ≈ 30 μl, AND OVERCHARGES THE LACRIMAL POOL. -FIVE MINUTES AFTER INSTILLING THE DROP, THE LACRIMAL POOL RETURNS TO ≈ 7 μl. -IT WAS MANDATORY TO LOOK FOR A SOLUTION TO THIS WASTE !

CISTERNOPLASTY A CISTERNOPLASTY QUADRUPLICATES THE CONTENT OF THE LACRIMAL BASIN, AND THE TIME OF RETENTION

THANKS FOR YOUR ATTENTION PUNCTUM PATCHING WITH 1. AUTOLOGOUS CONJUNCTIVA OR LID SKIN…… 2. AND CISTERNOPLASTY DO NOT CURE, …BUT GREATLY IMPROVE THE LIFE OF PEOPLE DEFINED IN THE TRIPLE CLASSIFICATION OF DRY EYE AS HAVING MEDIUM AND SEVERE DRY EYE

GARRET

ABDOMINAL RESERVOIR IS THE ONLY TECHNIQUE THAT ALLOWS TO PERFORM A SUCCESSFUL KERATOPLASTY IN TOTAL DRY EYES

PUNTUM PLUGS iniciated by Freeman in 1975

PUNCTUM PLUG

CAUTERIZATION OF THE LACRIMAL CANALICULI

TREATMENT OF DRY EYE 1. PSYCHOLOGIC 2. ENVIRONMENTAL 3. MEDICAL 4. SURGICAL

PUNCTUM PATCHING with AUTOLOGOUS SKIN